<!doctype html> 
<html>
  <head>
    <title>
      incription
    </title>
  </head>
  <body>
    <h1 style="text-align:center"> Formulaire d'insciption</h1>       
    <table align="center">
      <tr>
	<td> Nom</td>
	<td><INPUT type="text" size="x" maxlength="m" name="label1" value"texte"> </td>
      </tr>
      <tr>
	<td> Prenom </td>
	<td> <input> </td>
      </tr>
      <tr>
	<td> Mail </td> 
	<td> <INPUT type="text" size="x" maxlength="m" name="label2" value"texte"> </td>
      </tr>
      <tr>
	<td> Telephone </td> 
	<td> <INPUT type="text" size="x" maxlength="m" name="label3" value"texte"> </td>
      </tr>
      <tr>
	<td> Mot de Passe </td>
	<td> <INPUT type="password" size="x" maxlength="m" name="label4" value"texte"> </td>
      </tr>
      <tr>
	<td> <p>Adresse:</p> </td> 
      </tr>
      <tr>
	<td> Rue </td> 
	<td> <INPUT type="text" size="x" maxlength="m" name="label3" value"texte"> </td>
      </tr>
      <tr>
	<td> Ville </td> 
	<td> <INPUT type="text" size="x" maxlength="m" name="label3" value"texte"> </td>
      </tr>
      <tr>
	<td> Code Postale </td> 
	<td> <INPUT type="text" size="x" maxlength="m" name="label5" value"texte"> </td>
      </tr>
      <tr>
	<td> Pays </td> 
	<td> <select name="pays">
	    <option value="france">France</option>
	    <option value="allemagne">Allemagne</option>
	    <option value="italie">Italie</option>
	    <option value="Royaume-Uni">Royaume-Uni</option>
	  </select>
	</td>
      </tr>
      <tr>
	<td> <input type="button" value="annuler"> </td> 
	<td> <input type="submit" value="confirmer"> </td>
      </tr>
    </table>
  </body>
</html>
